The Last Page: Answers to questions from issue 55(2)

Answers to questions from issue 55(2)

Question 1: Given the family’s refusal to accept cocaine use, what further investigations (i.e. histologic, toxicologic, etc.) might be considered?

The family’s concerns need to be considered and the case should be further investigated.

Specimen chain of custody should be re-examined and verified. In this scenario, no discrepancies or irregularities were found upon re-inspection.

Histological examination should be performed. In this scenario, histological examination of the heart showed medial hypertrophy of small arterioles together with narrowed lumen, dense perivascular fibrosis, fatty infiltrates and hypertrophic myocytes with elongated abnormal nuclei and oedema. There was also intestinal fibrosis, monocyte infiltrate and transforming fibroblasts.

The case toxicology studies regarding cocaine should be expanded. In this scenario, in addition to the initial findings of cocaine, cocaethylene and benzoylecgonine confirmed present in the urine and cocaethylene and benzoylecgonine confirmed and quantified in the peripheral blood. The vitreous humour also had benzoylecgonine confirmed present as did the homogenized brain, liver and spleen.

Question 2: How should the cause of death be recorded given the case findings?

After consideration of the case history, scene investigation, witness statements, autopsy findings and laboratory results, the cause of death in this case should be recorded as acute cocaine toxicity and additional conditions should be documented including his obesity, type II diabetes, past myocardial infarctions and hypertensive cardiovascular disease.